From Stanford-UCSF Health Services (E.V.P.) and Stanford University
School of Medicine (Y.K., P.J.F., W.J.S., E.L.A., S.N.O., P.G.Y., S.H.S.),
Stanford, Calif, and the Heart Center Siegburg, Siegburg, Germany (E.G.).
Correspondence to Simon H. Stertzer, MD, Professor of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Room H2103, Stanford, CA 94305. E-mail simon_stertzer{at}cvmed.stanford.edu
Background—The validity of
quantitative coronary angiography (QCA) after stent placement
has been questioned because the optical density of a metallic stent,
added to the density of a contrast-filled lumen, could affect
border definition.
Methods and Results—We deployed 3.0- and 4.0-mm Palmaz-Schatz,
Wiktor, Multilink, NIR, and InStent stents in precision-cast phantoms.
Central lumens of 2.0 mm were created. There was no difference
between the "true" diameters of any stented lumen by both QCA and
quantitative ultrasonic (QCU) measurement poststenting. QCA systematic
error (SE) varied from 0.01 for the Wiktor stents to 0.14 mm for
the Palmaz-Schatz stents; the random error (RE) was 0.03 to 0.14
mm. QCU SE varied from 0.05 to 0.11 mm, and RE ranged from 0.01 to
0.07 mm. At the next stage, 4.0-mm Wiktor and Palmaz-Schatz stents
were deployed into the phantom lumens; 1.5-, 2.0-, 2.5- and 3.0-mm
lumens were created inside the stents. QCA and QCU measurements of 1.5-
to 2.5-mm residual lumens were overestimated by 0.1 to 0.3 mm. In
the 3.0-mm residual lumen within the Wiktor stent, QCA underestimated
the luminal size by -0.1 mm. There was no QCA inaccuracy for a
3.0-mm lumen within the Palmaz-Schatz stent. In patients, in 25 stented
segments in both the Palmaz-Schatz and Wiktor groups, there was no
difference between QCA and QCU diameters.
Conclusions—QCU is sufficiently precise for the assessment of the
coronary lumen after stenting. QCA can be used as an accurate
method of poststent assessment, except when a very mild
recurrence within a highly opaque stent is measured. In that
instance, QCA may underestimate the luminal diameter.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Coronary Stents
In Vitro Aspects of an Angiographic and Ultrasound Quantification With In Vivo Correlation
Key Words: stents • angiography • ultrasonics
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